Endometriomas: Diagnostic Performance of US

TLDR

To determine the diagnostic performance of specific ultrasonographic (US) features in discriminating endometriomas from other adnexal masses. Two sonologists independently reviewed 252 sonograms of 226 women using a standardized checklist to evaluate US features and overall reviewer impression for distinguishing endometriomas. Diffuse low‑level internal echoes were present in 95 % of endometriomas versus 19 % of non‑endometriomas (LR + 5), and the likelihood ratio rose to 8 when neoplastic features were excluded and to 48 with multilocularity or hyperechoic wall foci, enabling identification of 30 (75 %) and 18 (45 %) endometriomas respectively.

Abstract

To determine the diagnostic performance of specific ultrasonographic (US) features in discriminating endometriomas from other adnexal masses.Two sonologists independently reviewed the sonograms of 252 adnexal masses in 226 women and recorded US features by using a standardized checklist. The diagnostic performance of specific US features and overall reviewer impression in discriminating endometriomas from other adnexal masses were evaluated.There were 40 endometriomas. Diffuse low-level internal echoes were present in 38 (95%) endometriomas and 40 (19%) nonendometriomas (positive likelihood ratio, 5). The positive likelihood ratio for the diagnosis of endometrioma increased to 8 if masses with neoplastic features at gray-scale US were excluded, allowing identification of 30 endometriomas (75%). The presence of multilocularity or hyperechoic wall foci further increased the positive likelihood ratio to 48, allowing the identification of 18 endometriomas (45%).An adnexal mass with diffuse low-level internal echoes and absence of particular neoplastic features is highly likely to be an endometrioma if multilocularity or hyperechoic wall foci are present. A patient with a mass with diffuse low-level internal echoes and other US features may benefit from additional imaging.